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Surgical Correction for Pediatric Epiblepharon and Trichiasis
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Aesthetic considerations in upper eyelid retraction surgery.

Konstantinos I Papageorgiou1, Michael Ang, Shu-Hong Chang

  • 1Department of Ophthalmology, Jules Stein Eye Institute, Division of Orbital and Oculoplastic Surgery, University of California Los Angeles, Los Angeles, California 90095, USA. papagks@yahoo.com

Ophthalmic Plastic and Reconstructive Surgery
|November 10, 2012
PubMed
Summary

Modifying the tarsal platform in posterior eyelid retraction surgery significantly impacts aesthetic outcomes in thyroid-associated orbitopathy patients. This surgical approach offers good eyelid contour control but has limitations in managing orbital fat, necessitating individualized treatment decisions.

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Area of Science:

  • Ophthalmology
  • Plastic Surgery
  • Thyroid Eye Disease

Background:

  • Thyroid-associated orbitopathy (TAO) often causes eyelid retraction, affecting aesthetics.
  • Traditional assessments focus on eyelid margin position and marginal reflex distance.
  • Tarsal platform show (TPS) is a key, yet often overlooked, component of upper eyelid contour.

Purpose of the Study:

  • To evaluate the hypothesis that modifying the tarsal platform during posterior eyelid retraction surgery impacts aesthetic outcomes.
  • To assess the role of tarsal platform modification in achieving desirable cosmetic results in TAO patients.

Main Methods:

  • Retrospective analysis of 36 TAO patients undergoing primary eyelid retraction surgery by a single surgeon.
  • Exclusion of patients who had surgery concurrently with orbital decompression.
  • Surgical technique involved posterior approach conjunctival release and levator aponeurosis recession, with specific attention to lateral flare.
  • Outcome measures included TPS, brow fat span, and eyelid margin symmetry, assessed via masked evaluation of standardized photographs.

Main Results:

  • Fifteen patients (24 eyelids) were included, with a mean follow-up of 6 months.
  • Mean TPS significantly increased post-surgery (2.27 mm to 4.77 mm, p < 0.05).
  • Brow fat span remained statistically unchanged (13.22 mm to 13.25 mm, p > 0.05).
  • Masked observers confirmed the relevance of TPS in improving eyelid contour and symmetry.

Conclusions:

  • Control of tarsal platform show (TPS) is crucial for aesthetic success in upper eyelid retraction surgery.
  • Posterior approach surgery effectively improves eyelid contour but has limitations in addressing orbital fat and volume.
  • Individualized surgical approach selection (anterior vs. posterior) is essential, considering patient-specific factors like ethnicity, bony asymmetry, and brow fat span.